SPM 200
Clinical Skills Lab 3
IV’s
Daryl P. Lofaso, M.Ed, RRT
Indications for IV
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Indications:
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Intravenous access to patient’s circulatory
system.
Administration of Meds. & Fluids, as well as
blood collection
Contraindications:
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IV access should be attempted as distal as
possible.
Avoid veins that cross over joints, local
infection/injury
Extremities with renal shunts or fistulas
Common IV sites
IV catheter Size
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Age
< 1 year: 22, 24 gauge (g)
1-8 years: 18, 20, 22 gauges
> 8 years: 16. 18, 20 gauges
IV Procedure
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Use universal precautions (glove and eye
protection)
Allergies (betadine or latex)
Explain procedure to Pt.
Prepare all material
Select vein. Apply tourniquet above the
elbow.
Prepare site
IV Procedure (cont.)
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Warn the pt of possible pain
Bevel up at 30 degree above horizontal
Look for flashback of blood into catheter
Upon seeing flashback, advance catheter
another millimeter or two
Advance the sheath completely into the
vein and release tourniquet
IV Procedure (cont.)
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Connect the IV tubing/heplock
Secure catheter and tubing
Dispose of needles in sharps container
Document the IV site, catheter size and
date on the patient’s chart
Risks to YOU
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Risks after needle Sticks Exposure
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Hepatitis B:
6 - 30%
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Hepatitis C:
HIV:
3 - 10%
0.3 %
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Other blood borne pathogens
Steps to prevent
needle sticks
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Wear gloves
Do Not Bend or Break Needles
Never RECAP!!!
If you must, use the One Handed technique
Take your time
Dispose of contaminated needles
immediately in puncture-resistant containers
ACCIDENTAL NEEDLE
STICKS
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Immediately wash injured area.
Report all needle sticks immediately to your instructor or
immediate supervisor.
Complete an incident report and report to employee
health or ED.
Determine if the needle was clean or dirty.
Cleansing wound with antiseptic.
Request that the identified patient be tested for Hepatitis
B surface antigen and HIV antibodies.
Have your blood tested for Hepatitis B and HIV
antibodies as soon as possible.
Begin drug treatment (if necessary) & counseling.
How to calculate
patient’s fluid rate
Maintenance Fluid: Adult or Peds
Fluid Disturbances
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Isotonic Imbalances
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Fluid volume deficit
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Losses from GI
Loss of plasma or whole blood
Fever
Diuretics
Fluid volume excess
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CHF
Renal Failure
Cirrhosis of liver
Fluid Disturbances
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Osmolar Imbalances
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Hyperosmolar imbalance
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Diabetic ketoacidosis
Osmotic diuresis
Hypoosmolar imbalance
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SIADH
Excess water intake
(cont.)
Electrolyte Imbalances
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Hyponatrema
Hypernatrema
Hypokalemia
Hypocalcemia
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Hypercalcemia
Hypomagnesemia
Hypermagnesemia
Risk Factors for Fluid, Electrolyte,
and Acid-Base Imbalances
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Age
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Chronic disease
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Crush or head injuries or burns
Therapies
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CA or Cardiovascular disease (CHF)
Trauma
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Very old or very young
Diuretics, steroids, IV therapy, TPN
Gastrointestinal losses
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Gastroenteritis, NG Suction or fistulas